POS1063 CARDIOVASCULAR AND THROMBOEMBOLIC EVENTS IN RHEUMATOID ARTHRITIS AND PSORIATIC ARTHRITIS PATIENTS OVER 3 YEARS BEFORE AND 3 YEARS AFTER INITIATION OF A FIRST ADVANCED THERAPY. DATA FROM THE UNIVERSITY OF SHERBROOKE REGISTRY OF ADVANCED THERAPIES (USRAT)
Authors: G. Boire, N. Carrier, S. Roux, H. Allard-Chamard
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Uncontrolled inflammation increases the risk for cardiovascular (CV) and venous thromboembolic (TE) events. Reducing inflammation using advanced therapies (AT) is expected to reduce these risks. Clinical registries are best for precise observations on diagnosis, reasons for drug withdrawal, and disease activity. Administrative databases are more comprehensive for comorbidities and outcomes. <h3>Objectives</h3> To compare the incidence of CV and TE events before and after AT initiation in the same rheumatoid arthritis (RA) patients, to explore specific toxicities or poorer protection of some ATs. <h3>Methods</h3> USRAT Registry combines administrative and clinical data. Our team is the single one treating rheumatology patients among over 500,000 people. All their inpatient episodes are recorded in the administrative system of one single multisite hospital. Since 2003, we developed a registry of 1800+ patients treated with AT. Episodes of inpatient care for these patients were extracted from our hospital's database from 1995 up to the end of 2021. Clinical charts were revised to confirm diagnosis and disease activity over time. We report severe CV and TE events occurring over the 3 years before and the 3 years after initiation of a first AT in patients for which chart revision is currently completed. We analyzed data according to initial AT, identifying a large subset remaining on first AT (First Persistent), a small subset who stopped first AT but did not switch (First-Stop), and others who switched AT over the period (Switch) <h3>Results</h3> RA was confirmed in 596 (66.3% women; mean age 59.1). Mean disease duration at first AT initiation (anti-TNF in 61%) was 7.3 years. First Stop patients trended to be men (47.6%) vs 34.8% (First Persistent) and 30.1% (Switch) (p = 0.074). Switch patients were younger (57.9 yo vs 59.8 First Persistent and 60.8 First Stop) (p = 0.04). Mean duration of first AT treatment was similar in Switch and First-Stop (0.94 vs 0.93 y), versus 5.3 in First Persistent. Incidences of CV (1.57/100 person-years (py)) and TE (0.34/100 py) events before first AT were similar across First-Persistent, Switch and First-Stop subsets (Table 1). Over the 3 years after first AT initiation, we noted a numerical (non-significant) increase in new CV (2.35/100 py) and TE (0.67/100 py) events. CV incidence post-AT was significantly higher in the First-Stop subset, and not significantly different between First Persistent and Switch patients. After initiation of a first AT, TE events were numerically higher in Switch (1.05/100 pt-y) and First Stop (2.33/100 pt-y) than First Persistent (0.26/100 pt-y) patients. <h3>Conclusion</h3> Prescribing an AT to patients with active RA appears insufficient to bring their 3-year risk for CV and TE events below their pre-AT levels. The worst CV and TE outcomes were seen in patients who stopped their first AT and did not switch (First-Stop) over the observation period, compatible with persistent poorly controlled inflammation. Numerically higher TE but not CV events were seen in Switch relative to First-Persistence patients. First-Stop patients did not have more CV or TE events before AT initiation; other characteristics of the more at risk First-Stop patients are to be defined. <h3>Acknowledgements</h3> We acknowledge the contribution to our Registry of our staff rheumatologists: Guylaine Arsenault, Lyne Bissonnette, Alessandra Bruns, Pierre Dagenais, Artur Fernandes, Patrick Liang, Javier Marrugo, Ariel Masetto. <h3>Disclosure of Interests</h3> Gilles Boire Consultant of: Advisory committees: Abbvie Canada, Janssen Canada, Lilly Canada, Mylan Canada, Novartis Canada, Samsung Bioepis, Sanofi Canada, Teva. Honorarium for presentations: BMS Canada, Janssen Canada, Orimed, Viatris, Grant/research support from: Local PI in multicentric trials: Merck Canada, Pfizer Canada. Unrestricted financial support for investigator-initiated initiatives: Lilly Canada, Pfizer Canada, Nathalie Carrier: None declared, Sophie Roux: None declared, Hugues Allard-Chamard: None declared.